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Case series
Feasibility and safety of transradial access for pediatric neurointerventions
  1. Visish M Srinivasan1,
  2. Caroline C Hadley1,
  3. Marc Prablek1,
  4. Melissa LoPresti2,
  5. Stephanie H Chen3,
  6. Eric C Peterson4,
  7. Ahmad Sweid5,
  8. Pascal Jabbour5,
  9. Christopher Young6,
  10. Michael Levitt6,
  11. Joshua W Osbun7,
  12. Jan-Karl Burkhardt2,8,
  13. Jeremiah Johnson2,
  14. Peter Kan2
  1. 1 Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  2. 2 Department of Neurosurgery, Baylor College of Medicine, Houston, Texas, USA
  3. 3 Department of Neurological Surgery, University of Miami School of Medicine, Miami, Florida, USA
  4. 4 Neurological Surgery, University of Miami, Miami, Florida, USA
  5. 5 Neurological Surgery, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
  6. 6 Neurological Surgery, University of Washington, Seattle, Washington, USA
  7. 7 Neurosurgery, Washington University in St Louis School of Medicine, St Louis, Missouri, USA
  8. 8 Department of Neurosurgery, Texas Children's Hospital, Houston, Texas, USA
  1. Correspondence to Dr Peter Kan, Department of Neurosurgery, Baylor College of Medicine, Houston, TX 77030, USA; peter.kan{at}bcm.edu

Abstract

Background Diagnostic cerebral angiograms are increasingly being performed by transradial access (TRA) in adults, following data from the coronary literature supporting fewer access-site complications. Despite this ongoing trend in neuroangiography, there has been no discussion of its use in the pediatric population. Pediatric TRA has scarcely been described even for coronary or other applications. This is the first dedicated large study of transradial access for neuroangiography in pediatric patients.

Methods A multi-institutional series of consecutively performed pediatric transradial angiograms and interventions was collected. This included demographic, procedural, outcomes, and safety data. Data was prospectively recorded and retrospectively analyzed.

Results Thirty-seven diagnostic angiograms and 24 interventions were performed in 47 pediatric patients. Mean age, height, and weight was 14.1 years, 158.6 cm, and 57.1 kg, respectively. The radial artery measured 2.09+/-0.54 mm distally, and 2.09+/-0.44 mm proximally. Proximal and distal angiography were performed for both diagnostic and interventional application (17 distal angiograms, two distal interventions). Clinically significant vasospasm occurred in eight patients (13.1%). Re-access was successfully performed 11 times in seven patients. Conversion to femoral access occurred in five cases (8.2%). The only access-related complication was a small asymptomatic wrist hematoma after TR band removal.

Conclusions Transradial access in pediatric patients is safe and feasible. It can be performed successfully in many cases but carries some unique challenges compared with the adult population. Despite the challenge of higher rates of vasospasm and conversion to femoral access, it is worth exploring further, given the potential benefits.

  • angiography
  • catheter
  • technique
  • ultrasound

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Footnotes

  • Twitter @PascalJabbourMD

  • Contributors Author contributions to the study and manuscript preparation include the following: conception and design: Srinivasan, Kan; acquisition of data: all; analysis and interpretation of data: all; drafting the article, critically revising the article, and reviewed submitted version of manuscript: all authors; approved the final version of the manuscript on behalf of all authors: Srinivasan; study supervision: Kan.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial, or not-for-profit sectors.

  • Competing interests Dr Peterson is a consultant for Medtronic Neurovascular, Stryker Neurovascular, Penumbra, InNeuroCo, and Cerenovus, and is a stockholder in RIST Neurovascular. Dr. Kan is a consultant for Styker Neurovascular and Cerenovus.

  • Patient consent for publication Not required.

  • Ethics approval Institutional Review Board approval was provided by the organizing institution (Baylor College of Medicine, H-23688). Data collection was approved by other institutions and all information was de-identified. Informed consent was provided by patients’ guardians for this study of pediatric patients.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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